Q. It is in the family planning manual that the recommendation for frequency of Pap smears is found. They recommend thin-layer Paps every two years or conventional Paps every year. We are using thin layer Paps almost exclusively and we are doing them annually. Does this create a reimbursement issue? (11/2007)
A. The recommendation in the policy manual is consistent with national best practice guidelines and we strongly urge contractors to adhere to this policy. However, we are not currently limiting reimbursement if done more often. At this time, individual agency medical policy is determined by their respective medical director.
Q. EC only visits: Please confirm that EC can be delivered as a stand alone service. Many clients walk in for this and are not ready for a full family planning visit. If offered as EC only with no exam, what is permissible to bill and may EC only clients have the option of paying full fee to expedite the visit? (12/2007)
A. No, you do not have the option of providing the service at full fee. You must provide it based on your sliding fee scale. You may bill according to the service that is delivered to each client. This would inlcude the contraceptive method and the method specific counseling, at a minimum. You can also bill for whatever other service is provided. This would also be and excellent opportunity to let the client know she can return for a full array of service, including a long -term method of birth control.
Q. On the summary of changes, can you explain this one further? Section 11 chapter 1 -- removed 25% cap on Title XX reimbursement in a X/XX clinic. Does this mean we can charge copays higher than 25% of reimbursement to clients at or below 185% of poverty? (10/2007)
A. Yes, the 25% cap on Title XX co-pays has been removed for clinic sites that use Title X and XX funds. The co-pay that the client is charged must be based on a cost analysis of the cost of providing services at this site and the co-pay or fee the client is charged must adhere to agency's Title X/XX sliding fee scale.
Q. We typically charge a $3 dispensing fee for prescriptions filled in our pharmacy. Can we charge FP patients this dispensing fee? (11/2007)
A. A flat fee for dispensing prescriptions cannot be charged for either Title V or Title X/XX. Title V policy indicates that co-payment for Title V services may not exceed 25% of the authorized reimbursement allowed. Title X policy indicates that all charges must be based on a cost analysis of all services provided by the project and discounts. Title X policy also requires that no fees be charged to clients below 100% of poverty, and that clients between 101% and 250% of poverty, be charged on a schedule of discounts. No flat fees of any kind may be charged in either case.
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